Healthcare Provider Details

I. General information

NPI: 1659652063
Provider Name (Legal Business Name): JENNA SUSANNE CAPUTO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 REID AVE
BREEZY POINT NY
11697-1218
US

IV. Provider business mailing address

11 REID AVE
BREEZY POINT NY
11697-1218
US

V. Phone/Fax

Practice location:
  • Phone: 917-692-2710
  • Fax:
Mailing address:
  • Phone: 917-692-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: